Nursing Elites

1. A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

• A. Refer her for an exploratory laparotomy
• B. Measure serum gastrin in response to secretin infusion
• C. Treat her for H. pylori
• D. Obtain a dedicated small bowel series

Correct answer: B

Rationale: The next step after finding an elevated fasting serum gastrin level is to perform a secretin stimulation test. This test helps differentiate between gastrinoma and other causes of elevated gastrin levels, such as proton-pump inhibitor therapy or H2 antagonists. In gastrinoma, the serum gastrin level should further increase after secretin infusion, while in other conditions, the levels would not significantly rise. Exploratory laparotomy would be premature without confirming the diagnosis. Treating for H. pylori is not indicated as the diagnosis of gastrinoma is under consideration and not Helicobacter pylori infection. A dedicated small bowel series is not the next appropriate step in this scenario.

2. The preceptor is orienting a new graduate nurse to the critical care unit. The preceptor asks the new graduate to state symptoms that most likely indicate the beginning of a shock state in a critically ill client. What findings should the new graduate nurse identify?

• A. Warm skin, hypertension, and constricted pupils.
• B. Bradycardia, hypotension, and respiratory acidosis.
• C. Mottled skin, tachypnea, and hyperactive bowel sounds.
• D. Tachycardia, mental status change, and low urine output.

Correct answer: D

Rationale: Tachycardia, mental status change, and low urine output are early indicators of shock. In a critically ill client, these findings suggest a decrease in tissue perfusion. Prompt recognition and intervention are crucial to prevent the progression of shock and its complications.

3. The nurse is caring for a client with hyperthyroidism. Which intervention should the nurse implement to manage the client's condition?

• A. Provide a high-calorie diet.
• B. Encourage frequent rest periods.
• C. Restrict fluid intake.
• D. Administer a stool softener.

Correct answer: B

Rationale: Encouraging frequent rest periods is essential in managing hyperthyroidism as it helps address the fatigue and hypermetabolic state commonly associated with this condition. Rest is crucial to support the body's recovery and reduce the stress on the thyroid gland. While nutrition is important in managing hyperthyroidism, providing a high-calorie diet is not the priority intervention. Restricting fluid intake is not typically necessary unless there are specific indications such as heart failure. Administering a stool softener is not directly related to managing hyperthyroidism.

4. A 40-year-old woman presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The combination of symptoms including fatigue, polyuria, polydipsia, along with laboratory findings of hyperglycemia and ketonuria strongly suggest type 1 diabetes mellitus. In type 1 diabetes mellitus, there is a deficiency of insulin leading to high blood sugar levels (hyperglycemia) and the breakdown of fats producing ketones, causing ketonuria. Type 2 diabetes mellitus typically presents differently and is more common in older individuals. Diabetes insipidus is characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone, distinct from the provided clinical scenario. Hyperthyroidism may present with some overlapping symptoms like fatigue, but it does not account for the specific laboratory findings of hyperglycemia and ketonuria seen in this case.

5. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate?

• A. Bounding erratic pulse.
• B. Regularly irregular pulse.
• C. Thready irregular pulse.
• D. No palpable pulse.

Correct answer: D

Rationale: Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, asynchronous contractions of the ventricles, resulting in ineffective cardiac output. This leads to the absence of a palpable pulse. Nurses should be prepared to initiate immediate interventions such as defibrillation to restore normal cardiac rhythm in a client experiencing ventricular fibrillation.

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